Youth Resources of Southwestern Indiana Job Application - Youth Resources of Southwestern Indiana

Position Details

Position Sought

How did you learn about this open position?

Available Start Date

Are you currently employed?

Yes
No

Applicant Information

Applicant Name

First

Last

Permanent/Home Address

Address Line 1

Address Line 2

City

State

Zip Code

How long have you lived in the city/county listed above?

Cell Phone

Preferred Email

Preferred Pronouns

She/her
He/him
They/them
Other

Check all that apply.

Do you have a valid driver's license?

Yes
No

Do you have a means of getting to and from work?

Yes
No

Employment Eligibility

Are you legally eligible to work in the United States?

Yes
No

If you are not a U.S. citizen, are there any restrictions on your eligibility for employment?

Yes
No

Youth Protection

Have you at any time ever been convicted of or pleaded no contest to a crime?

Yes
No

Have you at any time ever been engaged in child molestation, exploitation, or abuse?

Yes
No

Have you at any time ever been accused of child molestation, exploitation, or abuse?

Yes
No

Are you aware of having any traits or tendencies that could pose any threat to youth or others?

Yes
No

Are you aware of any reason why you should not work with youth or others?

Yes
No

Are there any facts or circumstances involving you or your background that would call into question your ability to be trusted with the supervision, guidance, and care of youth?

Yes
No

Education

High School Attended

Name and Location

High School Graduation Date

MM/YYYY

Post-Secondary School Attended

Name and Location

Post-Secondary Graduation Date

MM/YYYY

Major/Degree Program

Scholastic Honors and/or Licenses

Employment History

Below you have the opportunity to list two previous jobs. You may include paid, volunteer & intern positions. If you have not worked before, please skip these questions and go to the next section.

Most Recent Employer

Company Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor Name

First

Last

Supervisor Title

Your Position Title

Start Date

MM/YYYY

End Date

MM/YYYY - If you are currently employed here, please type "N/A".

Reason for Leaving

Description of Duties

May Youth Resources contact this employer?

Yes
No

Other Past Employer

Company Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor Name

First

Last

Supervisor Title

Your Position Title

Start Date

MM/YYYY

End Date

MM/YYYY

Reason for Leaving

Description of Duties

May Youth Resources contact this employer?

Yes
No

References

Please list three (3) character references (no relatives or YR staff) and their contact information.

Reference #1

Reference #1 Name

First

Last

Work Phone

Cell Phone (If applicable)

Company/School

Relationship to You

How long have you known this reference?

Reference #2

Reference #2 Name

First

Last

Work Phone

Cell Phone (If applicable)

Company/School

Relationship to You

How long have you known this reference?

Reference #3

Reference #3 Name

First

Last

Work Phone

Cell Phone (If applicable)

Company/School

Relationship to You

How long have you known this reference?

Additional Information

Have you attended or volunteered at any Youth Resources programs or events? If yes, which programs/events and when?

Why are you interested in working at Youth Resources?

Why are you interested in this position specifically?

What kind of experience do you have working with youth?

What have you learned from your previous work experience?

Please list any other board, committee, or group memberships and your role in each.